PARANASAL SINUSITIS FOLLOWING ALLOGENEIC BONE-MARROW TRANSPLANT

In an attempt to identify major clinical features of paranasal sinusit is following allogeneic BMT, we reviewed 44 consecutive cases diagnose d at the Hammersmith Hospital between August 1993 and December 1995. A ll patients had symptoms and signs characteristic of sinusitis. Plain radiographs and/or CT scans revealed fluid levels in 86.4% of patients , opacification in 9.1%, and marked mucosal thickening in 4.5%. Two-th irds of patients were diagnosed within 120 days of BMT. The WBC was le ss than 1 x 10(9)/l in 16.3% of patients, the neutrophil count was les s than 0.5 x 10(9)/l in 18.6%, and serum immunoglobulins were depresse d (<6.7 g/l) in 40.6%. Grade III-IV acute GVHD was present in 25.6% of patients and grade I-II in 66.7%; 68.6% developed chronic GVHD. There were 70.5% of patients receiving corticosteroids. Specific pathogens could not be identified in most cases. Pneumonia was present in 10 pat ients, seven of whom had Aspergillus species identified by bronchoalve olar lavage. Parainfluenza virus was isolated in three patients and Ps eudomonas aeruginosa in two. Although all patients received antimicrob ial therapy, 70.5% developed chronic sinusitis. Fatal complications di d not occur. In 94 consecutive patients receiving allografts for CML d uring the period of study, WBC and neutrophil counts were lower 3 mont hs post-BMT in patients who developed sinusitis (P < 0.02). Patients r eceiving higher doses of total body irradiation (13.2 and 14.4 Gy) had a greater probability of developing sinusitis (P = 0.023). Sinusitis occurred in only one of 37 patients receiving autologous transplants i n the same period. Sinusitis is common following allogeneic BMT. Leuko penia is often present, but microbiological diagnosis is difficult, an d progression to chronic sinusitis common.